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Wisconsin rates for HCPCS 65286

Rpr Lac Appl Tissue Glue Wound Cornea&/Sclera

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.99 / $1,055.32 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.84 / $755.92 / $2,541.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $3,483.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.09 / $976.79 / $2,315.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,874.33 / $2,190.30 / $3,532.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.39 / $1,392.23 / $2,531.76
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.76 / $760.55 / $1,354.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.00 / $1,014.06 / $5,831.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.79 / $1,506.19 / $5,189.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.75 / $374.28 / $1,126.99
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$476.76 / $760.55 / $1,354.73
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.55 / $1,564.30 / $2,233.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,469.20 / $3,469.20 / $3,469.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.36 / $2,978.55 / $5,189.12
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,236.67 / $4,804.05 / $6,805.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,960.00 / $4,155.00 / $5,865.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.79 / $1,369.26 / $2,997.81